19 May 2020
Enhancing the safety and outcomes of patients begins with comprehensive continuous clinical surveillance practices. Clinicians often use the terms ‘monitoring’ and ‘surveillance’ interchangeably, but there are significant differences. Additional concepts that can further confound understanding are those of alarm management and alarm surveillance. These terms – monitoring, surveillance, alarm management and alarm surveillance – are not all interchangeable. While both alarm management and alarm surveillance prioritize patient safety, they differ. Monitoring and surveillance share similarities in data visualization, but they too are different.
Multiple internal and external factors attribute distinct characteristics to the term surveillance and have changed how clinicians apply critical thinking to patient care and safety. Alarm surveillance is fundamentally more than merely an informational guide for the clinician; it is an actionable and interventional assistant for facilitating patient care, particularly by providing a notification or alert to a front-line care provider when specific conditions associated with the patient state are met.1 For example, an alert can be generated when a patient experiences hypoxemia (i.e., low oxygen saturation levels below a targeted level) while simultaneously experiencing a pulse or heart rate that differs appreciably from the expected normal range.
Surveillance seeks to identify trends or changes in patient state that bear resemblance to conditions that may not be helpful to the patient – such as increasing heart rate or decreasing blood pressure or respirations over time. The recognition and analysis of data that allow for collaboration amongst clinicians is at the heart of surveillance, for it is through the continuous collection of data that retrospective assessments can be made that can ultimately lead to prospective insight of whether a patient is trending well or poorly. This shift from reactive clinical response is most notable with alarm management and alarm surveillance, in which directives or alerts are communicated to clinical staff in response to a detected event, towards prospective evaluation in anticipation and planning for future treatment. Monitoring is both a term representative of the continuous data collection of a patient with surveillance being the assessment and evaluation of those data – oftentimes, continuously – for the purpose of identifying patient states that deviate or “go off track” from desirable pathways. Understanding the distinctions between monitoring and surveillance represents the foundation of comprehensive patient safety initiatives and the ability to comply with — and even exceed — regulatory requirements for various types of software and hardware that purport to provide the function of surveillance.
Upon examining alarm management and alarm surveillance side-by-side, however, the differences are all-the-more distinct, as will be covered below.
Traditional alarm management systems detect and distribute medical device alarms triggered by changes in a patient’s condition subject to a priori constraints defined by clinical consensus or based on accepted protocols. By contrast, alarm surveillance begins with comprehensive, detailed patient data to enable tailored and sometimes condition-specific alarms (i.e., smart alarms) that provide a more targeted and more holistic view of patient status. Alarm surveillance seeks to filter out non-clinically actionable alarms from devices, giving way to more insightful readings that annunciate with improved clinical sensitivity and specificity. Alarm surveillance can draw upon data from multiple sources, including multiple medical devices associated with a patient, and data delivered both synchronously and asynchronously at potentially differing frequencies, from discrete low-frequency data to high-frequency waveforms.
As hospitals and clinicians are given more frequent access to innovative technologies that foster transparency, alarm surveillance brings the promise of reduced risk of false positive alarms while decreasing the likelihood of potentially deadly false negative misses – both of which are inherently consistent with improving patient safety. Medical devices regularly produce alarms sent to alarm management systems, which then distribute these alarms to designated care providers. Typically, distributed alarms from a conventional medical device fed alarm management system do not provide context or a detailed view of the patient’s condition. More informed data allow clinicians to make informed decisions faster, reduce alarm fatigue, and improve the level of care provided to patients. Proper surveillance tools help to reduce alarm fatigue and provide clear and concise patient assessment, thus serving as an essential adjunct of patient safety initiatives within the healthcare enterprise, improving bedside patient care management.
Alarm surveillance enables creating unique alarm signal annunciations by taking into consideration various features that are observed in the medical-device-originating raw data versus simply filtering alarms as issued by bedside medical devices. Custom alarm signals can be issued that are independent of the medical device. Capsule’s MDIP enables the creation of signals that are more clinically actionable by placing the power of alarm signal customization and tailoring in the hands of the clinician. Therefore, alarm signals generated using the surveillance portion of the MDIP are typically more clinically relevant to the specific patient condition, staff workflow, and context of the clinical environment.
Through Capsule’s MDIP and Alarm Surveillance solutions, alarm signals can be created, managed, and monitored centrally, while alarm notifications for any patient can be routed to a clinician remotely.2 Alarm signals can be customized for each patient or department, thereby mitigating the need to change settings on specific medical devices. This capability aids workflow and allows in-room medical devices to be set in compliance with hospital policy. In addition to enhancing workflow productivity, proper surveillance techniques help reduce clinician alarm fatigue.
The Association for the Advancement of Medical Instrumentation (AAMI) released recommendations to combat alarm fatigue, including creating detailed alarm management processes and determining when and where clinical alarms are unnecessary. The overarching theme of their findings centered on the need for constant patient oversight. Capsule’s alarm surveillance facilitates this oversight by providing the capability to create, manage, and monitor individualized alarms which can be configured and implemented on a per-patient basis. Yet, simply acknowledging and viewing the alarms is not enough. Capsule has the capability to create and set alarm limits for remote clinicians that are distinct from the alarm limits on the medical devices. Additionally, hospitals can utilize Capsule’s alarm analysis capabilities to determine the best configuration of alarm settings, including what is sent to the clinician’s phone or mobile device. This further aids in reducing non-actionable alarms and alarm fatigue.3
Advances in healthcare technology and distribution have made continuous alarm management and surveillance not just an achievable reality, but also an increasingly essential patient care management necessity for meeting enterprise objectives surrounding improved patient safety initiatives. Capsule understands just how essential quality patient care is and has used this insight to establish clinically actionable alarms that identify complex physiological interactions.
Ultimately, the Capsule Alarm Surveillance solution enables multiple independent measurements to be correlated and associated with user-defined clinically significant criteria. This allows hospitals and health systems to develop a comprehensive alarm surveillance strategy that can reduce the risk of alarm fatigue and improve overall patient safety, while also reducing alarm noise at the bedside to improve both patient and staff satisfaction.